Changes in Hemodynamic Parameters and Cerebral Saturation During Supraventricular Tachycardia

Abstract

Induced supraventricular tachycardia (SVT) during electrophysiology studies (EPS) can be associated with hemodynamic changes. Traditionally, invasive arterial blood pressure has been used for continuous monitoring of these changes. This prospective study evaluated the efficacy of near-infrared spectroscopy (NIRS) monitoring during SVT. The use of NIRS has expanded with evidence of its accuracy and benefit in detecting cerebral hypoperfusion. This study aimed first to determine the hemodynamic changes associated with electrophysiology testing for SVT and second to determine whether the hemodynamic changes are associated with similar changes in the cerebral saturation as determined by NIRS. The study enrolled 30 patients 5-20 years of age with a history of SVT who underwent an EPS. The demographic data included age, gender, weight, height, and type of SVT. Hemodynamic data (invasive blood pressure and heart rate), NIRS, bispectral index (BIS), end-tidal carbon dioxide, and pulse oximetry were collected before and during three episodes of induced SVT. The linear correlation coefficient (r) was measured to calculate the relationship of the changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) to the changes in NIRS values during the SVT episodes. Data from 22 patients were collected. The induction of SVT was associated mainly with a change in SBP and a less prominent change in DBP and MAP from baseline. The changes in hemodynamic status were associated with minimal changes in cerebral saturations, as evidenced by an average absolute change in NIRS of <1 from baseline value. The changes in hemodynamics were correlated linearly with cerebral saturation. Changes in SBP, DBP, and MAP were correlated positively with changes in NIRS, as denoted by (r) values of 0.52, 0.57, and 0.67 respectively, and a P value less than 0.05 for all three association tests. Induction of SVT during electrophysiology testing is associated with hemodynamic changes, mainly in SBP. In this study, these hemodynamic changes resulted in a minimal decrease in cerebral perfusion, as evidenced by minimal changes in the cerebral saturation measured by NIRS (0.7% from baseline). Although the changes in the cerebral saturation were minimal, these changes were linearly correlated with the changes in the hemodynamics. This study is the first to demonstrate the possible application of NIRS monitoring during EPS and to document that despite changes in the hemodynamic status, the changes in cerebral oxygenation are minimal, thereby confirming the safety of EPS for SVT.

Near Infrared Spectroscopy Monitoring in the Pediatric Cardiac Catheterization Laboratory

“…These findings differ from those reported by Hershenson et al. . A definite reduction in NIRS values was also observed in all cases of arrhythmia, other than SVT (complete AV block, IART, and asystole).…”

“…Hershenson et al. noted a fall in systolic blood pressure, but no obvious reduction in diastolic or mean blood pressure during SVT in patients monitored by cranial NIRS during electrophysiology studies. They also reported that, while there was a correlation between NIRS and the systolic, diastolic, and mean blood pressure, no obvious NIRS reduction could be observed during tachyarrhythmia.…”

Exploring the capability of wireless near infrared spectroscopy as a portable seizure detection device for epilepsy patients

“…In spite of this, it still cannot be ruled out that individual patient tailored seizure detection algorithms could be applicable for some patients. Supraventricular tachycardia has been reported not to cause notable changes in NIRS measured hemodynamics in the brain [18]. We found seizure induced pulse increase of at least 20 beats/ min in all 34 seizure analyzed and such could not find any relation between the NIRS changes during seizures and the seizure induced tachycardia.…”

Propofol Effect on Cerebral Oxygenation in Children with Congenital Heart Disease

“…This might explain the difference with the previously named study [5] where children after cardiopulmonary bypass may have an impaired cerebral auto-regulation. Indeed, in another NIRS study with children during electrophysiological examination with supraventricular tachycardia the changes in hemodynamics had a minimal impact on cerebral oxygenation [6].…”